Child Abuse-or Medical Mimic?

February 6, 2015

How good are your hunches when it comes to cases of possible child abuse? Can you determine which cases need to be reported to Child Protective Services and which require a medical diagnosis? See how well you do with the 5 cases presented here.

 

Question 1:

A 6-month-old girl is brought to the ED with fever, cough, and irritability. Both parents appear to be developmentally delayed but act appropriately under the circumstances. The child was born at 34 weeks and had a long, complicated stay in the NICU, during which she had received CPR on 2 occasions. The chest film indicates pneumonia; rib fractures are also noted. Records obtained from the NICU show there was no history of any fractures at time of discharge 3 months earlier.

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The correct answer is a. Abuse.
For a discussion of the case, click here.

 

Question 2:

A 4-year-old girl presents with these lesions that had started on the anterior aspect of the leg and had spread to the other leg and toward the groin. The mother is worried that these are sexually transmitted or abuse-related.

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The correct answer is b. Something else.
For a discussion of the case, click here.

 

Question 3:

A 4-year-old boy returns home after a day at a small private daycare with a bite mark on his forearm. The mother asks the child about the source of the bite, but he does not give any answers. She seeks a medical opinion and calls the police. The investigating officer is concerned about the daycare because of previous complaints concerning “other injuries.”

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The correct answer is a. Abuse.
For a discussion of the case, click here.

 

Question 4:

A 3-year-old child, the center of a heated custody dispute, is brought to the clinic by her maternal grandmother. The grandmother had not seen the child for 7 to 10 days. Before this visit, the grandmother could not recall anything wrong with the child’s hand. When the child was dropped off to her on this day, she noticed this lesion. The mother allegedly stated that the lesion had appeared after a 2-day visit with the father. There are no other similar lesions on any other body surface.

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The correct answer is a. Abuse.
For a discussion of the case, click here.

 

Question 5:

A 14-year-old boy presents to the abuse clinic at the request of Child Protective Services (CPS). According to CPS, the boy’s gym teacher had noticed multiple large bruises on his back, arms, and legs. The physical exam reveals 11 large bruises, with no specific pattern or uniformity to the bruises.

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The correct answer is b. Medical diagnosis. For a discussion of the case, click here.